Provider Demographics
NPI:1023198934
Name:MIECZNIKOWSKI, STEPHANIE (RDH)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:MIECZNIKOWSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1039 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6665
Mailing Address - Country:US
Mailing Address - Phone:319-337-2114
Mailing Address - Fax:319-337-3382
Practice Address - Street 1:1039 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6665
Practice Address - Country:US
Practice Address - Phone:319-337-2114
Practice Address - Fax:319-337-3382
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02679124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1495OtherANESTHSIA